Wound management – tetanus-prone wound management

This page provides clinical guidance on tetanus-prone wound management.

About tetanus-prone wound management

Tetanus is caused by a toxin released from Clostridium tetani, a spore-forming Gram-positive bacillus. Tetanus spores or bacilli can easily be introduced through injuries, even when the injury is trivial.

The following information about tetanus-prone wound management comes from 3D Regional HealthPathways, accessed January 2020:

Assessment

  1. Decide whether wounds or injuries are clean or dirty.
    • Clean – If minor, uncontaminated, non-penetrating injury, with negligible tissue damage, and less than 6 hours old.
    • Dirty – If any of the following:
                 · Wound may be infected or contaminated eg, with soil, dust, horse manure, or a re-implanted avulsed tooth.
                 · Penetrating injury eg, bite wounds, compound fractures, wounds containing foreign bodies.
                 · Wound is more than 6 hours old.
                 · Tissue damage eg, crush injuries, avulsions, burns.
  2. Check tetanus immunisation history for completed primary course and date of last booster. If the patient is a child, check their vaccination status on the National Immunisation Register (NIR).

Management

  1. Cleanse the wound thoroughly – irrigate the wound and debride any contaminated or non-viable tissue (necrotic tissue or slough).
  2. If the tetanus primary course is incomplete, provide tetanus vaccination. If the wound is dirty, also give tetanus immunoglobulin (TIG).
  3. If the tetanus primary course is complete, give tetanus vaccination if the wound is:
    • clean but more than 10 years since the last dose or booster.
    • dirty and more than 5 years since the last dose or booster.

Learn more

Guidelines for the management of tetanus-prone wounds The Immunisation Advisory Centre, NZ 
Spacing of Tdap after a Td vaccine The Immunisation Advisory Centre, NZ 
Tetanus Immunoglobulin-VF (for intramuscular use) data sheet Medsafe, NZ
Tetanus Immunisation Handbook, NZ, 2017

Reference

  1. Tetanus-prone wound management 3D Regional HealthPathways, NZ, 2020 
Credits: Health Navigator Editorial Team.